Critical Illness Insurance – What’s Covered

Critical Illness (24 Illnesses) coverage for Members of Doctors Manitoba.

For all eligible active Members of Doctors Manitoba under the age of 70, their spouses and dependent children.

Definition Payment of a lump-sum benefit when the insured person is diagnosed with a covered critical illness and survives 14 days following the diagnosis.
Voluntary Coverage Available for members and their spouses up to $500,000, to be medically underwritten. Coverage is guaranteed with no medical questionnaire up to $60,000 for members and their spouses and Dependents are eligible for up to $20,000 with no medical questionnaire should they apply during the open enrollment period or within 31 days of becoming eligible.
Issue Ages Member and spouse under age 70 (issue age is based on age as at January 1 of each year). Dependent Child under age 21 or under age 25 and in attendance at an Institution for Higher Learning on a full-time basis.
Covered Critical Illnesses (member, and spouse under the voluntary program)

Aortic Surgery Dilated Cardiomyopathy Multiple Sclerosis
Benign brain tumour Fulminant viral hepatitis Muscular dystrophy
Blindness Heart Attack Occupational HIV Infection
Cancer (life-threatening) Kidney failure Paralysis
Coma Loss of speech Parkinson’s disease and specified atypical Parkinsonian disorders
Coronary Artery Bypass Surgery Major organ failure on waiting list Primary pulmonary hypertension
Deafness Major organ transplant Severe burns
Dementia, including Alzheimer’s disease Motor Neuron disease Stroke

Covered Critical Illnesses (dependent child under the voluntary program)

Blindness Cystic Fybrosis Mental deficiency
Cancer (life-threatening) Deafness Muscular Dystrophy
Cerebral Palsy Down’s Syndrome Paralysis
Coma Loss of Speech Severe Burns
Congenital Heart disease requiring surgery Major organ transplant Spina bifida cystica

Frequently Asked Questions (Voluntary Coverage)

  1. How do we enroll?
    Doctors Manitoba will provide you with the enrollment forms that must be completed and returned to them within the enrollment period.
  2. How can one apply for a coverage amount higher than the guaranteed issue limit?
    To apply for amounts in excess of the guaranteed issue limit as described under the “Voluntary Coverage” section, please indicate the “Total amount” of coverage you are applying for in the application. Doctors Manitoba will work with you to obtain the necessary information and documentation for coverage exceeding guaranteed issue amount.
  3. I have a pre-existing condition, should I enroll in the program?
    Do not discount your insurability. Even if you are not medically approved you still have the option to buy an insurance coverage up to the guaranteed issue amount. The pre-existing condition limitation is only for 24 months. Depending on yoru medical condition, you may lose the pre-existing condition limitation after 24 months of being insured.
  4. I have a pre-existing condition; can I still make a claim?
    The Critical Choice-Care program covers 24 critical illnesses. The pre-existing condition limitation applies only if you are diagnosed with an illness that is linked to your pre-existing condition. Nevertheless, you must submit your claim because each claim is reviewed on its own merits.
  5. What happens to incomplete Application forms?
    Incomplete Application Forms are returned to the applicant immediately. Delays in processing the application may result.
  6. When does the insurance take effect?
    For persons who have applied for coverage for amounts less than or equal to the guaranteed issue limit only, insurance will take effect on the 1st of the month coinciding with or following the date the online enrollment is saved and confirmed, but no earlier than January 1, 2020.
    For persons who have applied for coverage in excess of the guaranteed issue limit and submitted the Application Form, insurance up to the guaranteed issue limit will take effect on the 1st of the month coinciding with or following the date the online enrollment is saved and confirmed, but no earlier than January 1, 2020. The excess amount will become effective on the 1st of the month coinciding with or following the date of the approval by the insurer, but no earlier than January 1, 2019.
  7. How can one qualify for the reduced non-smoker rates?
    To qualify for the non-smoker rates the applicant must not have used smoking materials (cigarettes, cigars, pipe, chewing tobacco, nicotine patch or nicotine gum) or used tobacco in any other form within the last 12 months.
  8. Will I remain entitled to long term disability benefits (LTD) benefits if I receive a benefit for a critical illness?
    The critical illness benefit will not affect your long term disability payments.
  9. How can I make changes to my coverage?
    Changes to coverage can be requested within 31 days of a Life Event or during the yearly enrollment period of the insurance program or within 31 days of another Life Event. Please notify Doctors Manitoba of pertinent changes and complete the documentation they provide you.
    To apply for an increase in insurance amount greater than the guaranteed issue limit, a new Application Form must be completed and submitted to the Insurer via Doctors Manitoba for approval. Same applies for a reduction in insurance amount.
  10. How do I file my claim?
    Filing a claim is a very simple process. You should notify Doctors Manitoba of your claim, either in writing or verbally, as soon as you are diagnosed with a covered illness. Doctors Manitoba will verify your coverage an notify the insurer that they received a notice of claim from you. The insurer will send you a letter and claim forms pertaining to your illness after receiving the notice from Doctors Manitoba.
  11. Will I remain insured for critical illness after having received a benefit under this program?
    Yes, coverage remains in force after the payment of a benefit, subject to the limitations specific in the Re-Entry Exclusions section of the member booklet.
  12. What is the Second medical opinion program?
    The Insurer, in cooperation with AXA Assistance Canada agrees to provide the Section Medical Opinion Program to all Insured Persons.
    Please refer to the member booklet in order to read about what the Second Medical Opinion Program provides to you and your spouse.

The purpose of this document is to provide a summary description. It is not intended to describe all provisions, exclusions and limiations applicable to a benefit or to a specific insurance policy. For complete description of the provisions, exclusions and limitations that apply, please refer to the contract. In this document SSQ refers to SSQ Insurance.